Ann Connealy lived her first 50 years without ever being a patient in a hospital. Her run of good luck ended with a diagnosis of cancer of the appendix in 2007. After an appendectomy and six rounds of chemotherapy, she was cautiously optimistic.

Three years later, the Pilger, Neb resident was back in the hospital. Her cancer had returned. But instead of feeling unlucky, Connealy said she felt fortunate to be in Nebraska, when her doctor in Norfolk referred her to Jason Foster, MD, a surgical oncologist at The Nebraska Medical Center who specializes in a new and emerging treatment for abdominal cancer.

"He does not give up," Connealy said. "He operated on me for more than 12 hours. He did everything."

Dr. Foster is one of a very small number of surgical oncologists in the United States practicing this approach.

During the operation, Dr. Foster removed all the visible cancer from Connealy's organs. Then, using a process known as hyperthermic intraperitoneal chemotherapy (HIPEC) or hot chemo, he and the surgical team bathed her organs in a heated solution of chemotherapy to kill the microscopic cancer cells which almost certainly still remained.

"With this approach, we do the surgery and the chemo all at once," Dr. Foster explained. "It complements the IV chemotherapy she received and allows us to treat the organ surfaces and inner abdominal walls which could have been exposed to the cancer.

The typical course or conventional approach for a patient like Connealy would be multiple surgeries to remove some of the tumors, followed by multiple rounds of chemotherapy each time her disease recurred. Unfortunately, 65-80 percent of abdominal cancers like Conealy's will recur, Dr. Foster said. And in Conealy's case her tumor did recur 2-3 years after traditional therapy.

HIPEC solution is heated and placed in the patient's abdomen

The hot chemo (HIPEC) approach is well-suited for treating cancer in the abdominal cavity since the organs and inner abdominal wall are at risk, and the cancer cells can spread from one area to another.

After removing the visible tumors, surgeons close the abdomen, and fill the abdominal cavity with the heated chemo and bathe all the organs with the solution.

The cancer-fighting benefit does not just come from the high dose chemo solution itself.

"Cancer cells do not dissipate heat well and can be killed by heat; we know that from research," Dr. Foster said. "So for this to work, we had to find a temperature warm enough to kill the cancer cells, but not too hot to damage the healthy tissue inside the body."

That temperature is 42 degrees Celsius, or 108 degrees Fahrenheit.

Hot chemo treatments can be used for some patients with ovarian and colorectal cancer, and is the primary treatment for cancer of the appendix and peritoneal mesothelioma.

"The exact treatment is different for each patient and depends on the type of cancer they have," Dr. Foster said. "But the concept is generally the same."

Patients who are candidates for hot chemo treatment are facing very steep odds. They are typically stage four cancer patients and in many cases have already experienced surgery and chemotherapy.

"Ideally we would like to see all patients at the time of diagnosis to avoid multiple surgeries but often patients are not aware of this option until they relapse", said Dr Foster.

For some people, the treatment has the potential to save a life. In others, it is used to make the remaining months or years more tolerable.

"In some cases, it's a quality of life issue," said Dr. Foster. "A patient may be looking at spending what time they have left undergoing traditional chemo and the side effects that sometimes come with it. For the right person, this can be a viable alternative; improving their quality of life and potentially extending their survival.

Jason Foster, MD

"There is more research to be done," Dr. Foster said. "Can this approach work in other parts of the body? Maybe."

Ann Connealy's outlook is positive. Her surgery behind her, her future will hold at least a few traditional chemotherapy treatments.

"It's just to be sure there's nothing else still there," she said. "But I have a good gut feeling this time."

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